Application Number : LOURDES MATHA COLLEGE OF SCIENCE & TECHNOLOGY Lourdes Hills, Kuttichal P O, Thiruvanathapuram – 695574 | Phone : 0472-2853550 / 2853546 Fax : 0472-2853846 | E-mail : [email protected] | Website : www.lmcst.ac.in | City office : 0471-2302481 Minority Status Educational Institution | Approved by AICTE & Affiliated to the Kerala Technological University Member of Kerala Catholic Engineering College Managements' Association Managed by Lourdes Matha Catholic Educational Society An ISO 9001-2008 certified institution APPLICATION FORM FOR ADMISSION TO B.TECH LATERAL ENTRY SCHEME 2015- '16 Allotment code : DD/Cash Receipt No : LMC Dated : Affix a recent stamp size photograph of the Applicant ( Fill in Block Letters or Tick wherever is applicable) (Do not Staple) 01. NAME OF APPLICANT (As entered in 10th certificate) 02. DATE OF BIRTH D D 04. RELIGION M M Y Y Y 03. GENDER Y M F 05. CASTE 06. COMMUNITY Permanent Communication 07. ADDRESS PIN PIN 08. PHONE NUMBER 09. E-MAIL ID 10. FATHER’S NAME OCCUPATION 11. MOTHER’S NAME OCCUPATION 12. NATIONALITY 13. ANNUAL FAMILY INCOME 14. DETAILS OF EDUCATIONAL QUALIFICATIONS (SSLC/HSE/CBSE/ISC/OTHERS) EXAM [ Kerala BOARD COURSE YEAR OF PASSING HSE/CBSE/ISC/VHSC/ Others (specify) ] X XII NAME OF INSTITUTION PERCENT AGE OF MARKS 15. DETAILS OF QUALIFYING EXAMINATION (DIPLOMA / OTHERS) : COURSE UNDERGONE NAME OF INSTITUTION BOARD / UNIVERSITY 16. KERALA LATERAL ENTRY ENTRANCE EXAMINATION DETAILS REGISTER NUMBER LET RANK 17. MARKS/ PERCENTAGE PER SEMESTER OF DIPLOMA EXAMINATIONS SEMESTER PERCENTAGE GPA SEMESTER S1 S2 S3 S4 S5 S6 PERCENTAGE GPA 18. BRANCH OPTED DECLARATION BY THE APPLICANT I, …………………………………………………… solemnly declare that the details furnished are true. I also undertake that any wrong information furnished by me will forfeit my claim for admission. I will obey the rules and regulations of the instituion, if admitted. I shall submit all certificates and documents in original at the time of admission, failing which my admission will be liable for cancellation. I shall not resort to ragging in any form at any place and shall abide by the rules/laws prescribed by Courts, Governments, affiliating University & College authorities for the purpose from time to time. Place : Date : Name & Signature of the Applicant DETAILS OF TRUE COPIES TO BE SUBMITTED ALONG WITH THE APPLICATION 1 SSLC/ Equivalent Certificate. 2 Marklist of +2/CBSE/ISC. 3 Mark list of qualifying Examination & Certificate. 4 Admit card & Score card of Entrance examination (LET - 2015). 5 For downloaded application, a DD of Rs 500/- drawn in favour of Principal, LMCST payable at Trivandrum. 6 Certificate from the parish priest in the case of christian community. FOR OFFICE USE ONLY Certificates verified Fees paid Rs : ………………… Name and Signature of the Office Superintendent Admission No. : Admission Granted / Rejected Date of Admission : Orders of Director / Principal
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